The use of textured breast implants during augmentation or
reconstructive surgery can slightly increase a patient’s risk of developing Breast
Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), a form of cancer
that is distinct from other breast cancers. Now an
article recently published in Aesthetic
Surgery Journal formalizes the treatment strategy for this diagnosis,
offering clear guidelines for plastic and oncologic surgeons. The National
Comprehensive Cancer Network, U.S. Food and Drug Administration, and World Health
Organization all recommend the surgical technique known as stepwise en bloc
resection, which includes total capsulectomy (removing scar tissue around the implant), explantation (removal) of the implant,
complete removal of any associated masses, and removal of any involved (proven
by biopsy) or suspicious lymph nodes.

“With a complete oncologic resection of the lymphoma, the
prognosis for BIA-ALCL is very good,” says Sarah Tevis, MD, investigator at the
University of Colorado Cancer Center and assistant professor of Surgery at the
CU School of Medicine.

BIA-ALCL is diagnosed at a median 8-10 years after implantation of
textured implants. However, Tevis suggests that any patient with fluid
collection around the implant more than a year after surgery should be
evaluated for lymphoma.

“At the point
of diagnosis, it’s important to completely treat the condition with definitive
surgery,” Tevis says, writing that, “Incomplete resections, partial
capsulectomies, and positive margins are all associated with high rates of
disease recurrence and, in rare cases, accelerated progression of disease.”

Ongoing work seeks to define who is at highest risk for developing
BIA-ALCL. For example, Tevis and colleagues recently published a
small study in Aesthetic
Surgery Journal showing that women who develop the condition are more
likely than the general population to have a genetic difference leading to lack
of a specific immune system protein called HLA-A26.

“We’ve seen that there may be a role for chronic inflammation in
increasing the risk of implant-associated lymphoma. Now we see that changes in
HLA genes and other genetic changes could predispose some women to develop
breast implant-associated lymphoma,” Tevis says, noting that more work is
needed to explore this idea, and that surgeons or other professionals who
encounter cases of BIA-ALCL can submit patient cases through the Plastic Surgery
Foundation PROFILE Registry.
This registry may help researchers identify risk factors for the condition and
guide management of patients with the disease.

According to Tevis, the risk of implant-associated lymphoma is
small, and the condition is most often surgically corrected, but, “we’re seeing
more and more of it, so we feel strongly it should be involved in the consent
process for patients receiving these textured implants.”

“Our hope,” Tevis says, “is that by raising awareness of common
presenting symptoms, proper treatment strategies and by continuing to build our
understanding of the inner workings of BIA-ALCL, we can successfully treat the
women who need treatment and, eventually, identify who is at highest risk for
developing the disease.”